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This is VAERS ID 323866

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 323866
VAERS Form:
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 2 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C86145 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Barium enema abnormal, Full blood count, Haematochezia, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnorma
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussuscept"ion. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 12/8/2009

VAERS ID: 323866 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 2 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C86145 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Barium enema abnormal, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Mucous stools, Platelet count decreased, Pyrexia, Red blood cell count decreased, White blood cell count normal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnorma
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''''d dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussuscept"ion. Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 3/2/2010

VAERS ID: 323866 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 2 UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C86145 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Mucous stools, Platelet count decreased, Pyrexia, Red blood cell count decreased, White blood cell count normal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnorma
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 4/7/2010

VAERS ID: 323866 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 2 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C86145 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Mucous stools, Platelet count decreased, Pyrexia, Red blood cell count decreased, White blood cell count normal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnorma
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 8/31/2010

VAERS ID: 323866 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 2 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C86145 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Mucous stools, Platelet count decreased, Pyrexia, Red blood cell count decreased, White blood cell count normal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnorma
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 5/13/2013

VAERS ID: 323866 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86145 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Mucous stools, Platelet count decreased, Pyrexia, Red blood cell count decreased, White blood cell count normal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnorma
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 4/14/2017

VAERS ID: 323866 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86145 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium enema abnormal, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Mucous stools, Platelet count decreased, Pyrexia, Red blood cell count decreased, White blood cell count normal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnorma abnormal-hemolyzed spec.
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 9/14/2017

VAERS ID: 323866 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 2 3 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 2 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 2 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86145 / 2 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnormal-hemolyzed spec.
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 2/14/2018

VAERS ID: 323866 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 3 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86145 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnormal-hemolyzed spec.
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 6/14/2018

VAERS ID: 323866 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 3 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86145 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnormal-hemolyzed spec.
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 8/14/2018

VAERS ID: 323866 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 3 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86145 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnormal-hemolyzed spec.
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 9/14/2018

VAERS ID: 323866 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 3 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86145 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnormal-hemolyzed spec.
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.


Changed on 10/14/2018

VAERS ID: 323866 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New Jersey
Vaccinated:2008-08-05
Onset:2008-08-22
Submitted:2008-08-26
Entered:2008-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 3 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1203R / 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86145 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1886U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: 7/3/08 - Bronchitis. PMH: none
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnsotics: Abd US (+) for evidence for IS. Abd X-ray suggestive of possible ileus. CBC with WBC 7.7, RBC 2.0-4.28, Hgb 5.5-11, Hct 16.1-33.3, platelets 65K-389K. Repeat specimen 3 hrs later all WNL. Chemistry abnormal-hemolyzed spec.
CDC 'Split Type':

Write-up: Baby to see pediatrician for bloody stools x 2 and fever 8-22-08. Dx hematochezia, R/O intussusception. Admitted to hospital and dx''d with positive intussusception on 8/22/08. 9/10/2008 ER rec received from CDC for DOS 8/22/08 with D/C DX: Intussusception. Infant presented with fever, decreased po intake and bloody/mucousy stool. Frank blood in diaper at PCP office. To ER to r/o IS. Barium enema used to confirm and reduce IS of the large bowel in the RLQ.

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